摘要
目的:探究甲状腺全切并中央区清扫时甲状旁腺原位保留联合半量移植的临床疗效。方法:回顾性分析我院2017年09月至2023年01月行甲状腺全切并中央区清扫术的128例甲状腺乳头状癌患者;按不同甲状旁腺处理方式分为原位保留组(n=58例)、原位保留联合半量移植组(联合组)(n=27例)及全移植组(n=43例),对于三组间患者临床及随访资料进行比较及统计分析。结果:联合组及全移植组术后PTH减低比例明显低于原位保留组(P<0.05);术后第7天时,联合组PTH减低比例(7.4%)低于全移植组(27.9%)(χ^(2)=4.356,P=0.037);联合组同全移植组出现永久性甲状旁腺功能低下患者比例(分别为0%和2.3%)明显低于原位保留组(12.1%)(χ^(2)=6.282,P=0.043);术后30天时联合组及全移植组低钙发生率(分别为3.7%和7%)明显低于原位保留组(27.6%)(χ^(2)=12.310,P=0.002)。结论:对于原位保留的甲状旁腺术中无法判断血供或血供可疑障碍时甲状旁腺原位保留联合半量自体移植作为双保险的方案优势明显;其术后甲状旁腺激素水平恢复速度快,发生永久性甲状旁腺功能低下比例低。
Objective:To investigate the clinical efficacy of parathyroid preservation in situ combined with half volume transplantation during total thyroidectomy and central area dissection.Methods:A retrospective analysis was conducted on 128 patients with papillary thyroid cancer who underwent total thyroidectomy and central area dissection in our hospital from September 2017 to January 2023.They were divided into three groups according to different parathyroid gland management methods:In situ preservation group(n=58 cases).In situ preservation combined with half volume transplantation group(n=27 cases),and total transplantation group(n=43 cases).Clinical and follow-up data of the three groups were compared and statistically analyzed.Results:The proportion of postoperative PTH reduction in the combined group and total transplantation group was significantly lower than that in the in-situ preservation group(P<0.05).On the 7th day after surgery,the proportion of PTH reduction in the combined group(7.4%)was lower than that in the total transplant group(27.9%)(χ^(2)=4.356,P=0.037).The proportion of patients with permanent hypoparathyroidism in the combined group(0%)and the total transplantation group(2.3%),which was significantly lower than that in the in situ preservation group(12.1%)(χ^(2)=6.282,P=0.043).At 30 days after surgery,the incidence of low calcium was significantly lower in the combination group(3.7%)and the total transplantation group(7%)compared to the in situ preservation group(27.6%)(χ^(2)=12.310,P=0.002).Conclusion:For parathyroid glands preserved in situ,the combination of parathyroid gland preservation in situ and half volume transplantation has significant advantages as a dual insurance plan when it is difficult to determine blood supply during surgery or when there is a suspected blood supply disorder.The postoperative recovery rate of parathyroid hormone levels is fast,and the proportion of permanent hypothyroidism is low.
作者
吴二斌
段宏罡
李彬彬
陈鹏杰
WU Erbin;DUAN Honggang;LI Binbin;CHEN Pengjie(The First People's Hospital of Pingdingshan City,the First Affiliated Hospital of Pingdingshan University,Henan Pingdingshan 467000,China.)
出处
《现代肿瘤医学》
CAS
2024年第6期1038-1043,共6页
Journal of Modern Oncology
关键词
全甲状腺切除
甲状旁腺
自体移植
total thyroidectomy
parathyroid gland
autologous transplantation
